STUDY DESIGN: Cross-sectional, semi-structured online survey.
METHODS: An anonymized, self-administered, semi-structured online survey was conducted via Google Forms between July and October 2024. Survey invitations were distributed via email, professional networks, and social media where appropriate. The survey assessed respondents' demographics, respondents' prior use of QPLs (Yes/No), prior awareness of the existence of QPLs (Yes/No), preferred communication style (single-response, multiple-choice), and perceived barriers and facilitators to implementation (open-ended response). All questions excluding the two open-ended questions were required for submission. Descriptive statistics were used to analyze quantitative data, and thematic analysis following Braun and Clarke's framework was used for open-ended responses.
RESULTS: Among 85 respondents, 84.7% reported being unaware of QPLs, and 22.4% reported having implemented QPLs in their clinical practice. Among respondents who had not implemented QPLs, 68.2% indicated that they were "Somewhat" or "Very" willing to implement them. Most respondents favored communication styles that emphasize sharing information (16.4%), open and inclusive communication (15.6%), and supportive counseling (15.6%). QPLs are aligned with current attitudes toward patient-provider communication in ANCCA countries.
CONCLUSION: There is substantial opportunity to introduce QPLs across ANCCA countries. This study provides foundational evidence to guide their effective implementation, promoting patient-centered care in Asia.
OBJECTIVES: To estimate the global, regional, and national burden of ischemic heart disease and ischemic stroke attributable to elevated LDL-C (relative to 35-54 mg/dL) from 1990 to 2023 and to quantify the contributions of population growth, aging, risk-deleted burden, and exposure changes to burden trends.
DESIGN, SETTING, AND POPULATION: This comparative risk assessment, part of the Global Burden of Disease Study 2023, estimated population-level LDL-C exposure and associated health loss in 204 countries and territories. Mean LDL-C levels were estimated using spatiotemporal gaussian process regression based on 806 studies across 161 countries. Relative risks were derived from meta-analyses of 38 randomized clinical trials. Population-attributable fractions for deaths and disability-adjusted life-years (DALYs) were estimated by age and sex for adults aged 25 years or older from 1990 to 2023, with 95% uncertainty intervals.
EXPOSURE: Population-level LDL-C concentrations.
MAIN OUTCOMES AND MEASURES: Population-attributable fractions, counts, and rates (all ages and age standardized per 100 000) of LDL-C-attributable deaths and DALYs from ischemic heart disease and ischemic stroke, with uncertainty intervals.
RESULTS: In 2023, elevated LDL-C accounted for 3.6 million deaths (95% uncertainty interval, 2.2-5.4 million; 6.0% of global mortality) and 90.7 million DALYs (95% uncertainty interval, 58.9-123.3 million; 3.2% of DALYs). Although global all-ages rates remained stable, age-standardized death and DALY rates decreased by 45.6% and 39.5%, respectively, since 1990. In 2023, age-standardized LDL-C-attributable DALY rates were highest in Eastern Europe and lowest in high-income Asia-Pacific. One-third of the global LDL-C burden occurred in India and China. Population growth and aging drove the increasing burden, with notable regional disparities in LDL-C exposure and risk-deleted DALY rates shifting toward middle-sociodemographic settings.
CONCLUSIONS AND RELEVANCE: Despite declining age-standardized rates, the absolute LDL-C burden has increased since 1990 due to demographic changes and has shifted toward middle-sociodemographic countries. Measurement and surveillance gaps persist. Strengthened prevention, diagnosis, and treatment access strategies are essential to mitigate the health burden of LDL-C.